Haemorrhoids / Piles: Every Person's Nightmare

Haemorrhoids / Piles

A friend who has haemorrhoids asked me to look into this. Here is what my research came up. I hope this helps.

Haemorrhoids, also known as piles are very common and have been afflicting humans for centuries. They develop when the veins in the anal canal become abnormally swollen and inflamed. Haemorrhoids result from increased pressure in the veins of the anus, causing the veins to bulge and expand, making them painful - particularly when sitting.

The most common cause of haemorrhoids is straining during bowel movements brought on by constipation, sitting for long periods of time, and anal infection. Other contributing factors include pregnancy, ageing, chronic constipation or diarrhoea, natural birth, and anal intercourse. In some cases, they can also be caused by other diseases, such as liver cirrhosis.

Haemorrhoids can develop inside the anal canal or near the opening of the anus – these types are classified as internal or external.

External haemorrhoids develop below the dentate line (a line that separates the two types of anal skin), and are generally painless. They rarely need medical treatment, unless a vein bursts, blood pools under the skin and a painful lump develops (this is called a clotted or thrombosed haemorrhoid).

Internal haemorrhoids develop above the dentate line. They can range in size from a slight swelling under the wall of the canal to large, sagging veins that protrude from the anus at all times. For treatment purposes, internal haemorrhoids are graded according to their size:

• Grade I: The vein bulges and may bleed during bowel movements.
• Grade II: The vein comes out of the anus during bowel movements, but goes back by itself.
• Grade III: The vein comes out during bowel movements, but doesn't go back by itself. It has to be replaced by hand.
• Grade IV: The vein protrudes from the anus at all times and cannot be replaced.

 Causes

Haemorrhoids result from increased pressure on the veins in the pelvis and rectal area that causes the veins to bulge and expand. The increase in pressure is commonly related to:

• Poor bowel habits – straining from long-term constipation or diarrhoea;
• Overweight, which often leads to straining to pass stools;
• Standing or sitting for long periods of time;
• Breathing improperly while lifting heavy weights (inhaling rather than exhaling while pushing against the weight);
• Pregnancy, which results in increased blood flow to the pelvic area;
• Pushing and pressure of natural childbirth
• Medical conditions, such as long-term (chronic) heart and liver disease, which causes blood to pool in the abdomen and pelvic area;
• Anal infections;
• Coughing, sneezing or vomiting;
• Genetic (inherited) factors.

Treatment

If the haemorrhoids diagnosis is confirmed, a treatment plan can be initiated.

Treatment of haemorrhoids depend on the degree of prolapsed and the extent of symptoms.

Home treatment and medication

Lifestyle changes are an integral part of treatment and can be used by patients with all stages of haemorrhoidal disease as a preventative measure. Here are some home-treatment techniques and remedies for small haemorrhoids:

• Do not sit for long periods of time. Take frequent breaks.
• Insert petroleum jelly on the inside rim of the anus to make bowel movements less painful.
• Stool softeners can reduce straining and constipation during bowel movements.
• Be gentle when wiping after a bowel movement. If toilet paper is irritating, try dampening it first, or use cotton balls or alcohol-free baby wipes. You may prefer washing yourself and then dabbing the area dry.
• It is important to keep the anal area clean and regular bathing is suggested. But be careful, excessive scrubbing, especially with soap, can intensify burning and irritation. Use soaps that contain no perfumes or dyes.
• Resist the temptation to scratch the area as this irritates the inflamed veins more, damages the surrounding skin and intensifies the itchiness.
• Ointments that contain hydrocortisone may help decrease inflammation and speed healing.
• Non-prescription pain relievers and nonsteroidal anti-inflammatory medicine can help with pain and swelling.
• To relieve pain and itching, apply ice several times a day for 10 minutes at a time. Follow this by placing a warm compress (such as a warm, damp towel) on the anal area for another 10 to 20 minutes.

External haemorrhoids

• External haemorrhoids usually do not need surgical treatment, unless an enlarged vein near the anus bursts, forming a hard and extremely painful lump under the skin (thrombosed haemorrhoid).
• If the pain is not too severe, stool softeners, topical pain-relieving creams and Sit baths (sitting in a bathtub of warm water for 15 minutes several times a day, especially after a bowel movement) may be sufficient.
• If pain is severe, surgical treatment may be required. If the lump is not removed within 24 to 48 hours, the pain will gradually lessen over the next four to five days. The skin covering the lump may break open on its own, causing mild bleeding. With good self-care, pain and bleeding stop within two weeks (although the lump may remain for several weeks).

Internal haemorrhoids

• Anaesthetising creams and suppositories to reduce inflammation may relieve irritation and pain due to internal haemorrhoids.
• Internal haemorrhoids that continue to bleed after a trial of home treatment or become so large that they stick out of the anus may require professional treatment.

Prevention

Initial treatment for haemorrhoids begins at home. Since haemorrhoids are made worse by straining to pass stools, changing some of your daily habits to promote regular, smooth bowel movements may help relieve symptoms and keep haemorrhoids from worsening. Half of all haemorrhoid sufferers find relief with dietary changes alone.

• Avoid constipation by eating high-fibre foods (fruits, vegetables, whole grain breads, beans, and legumes) and avoiding refined and "junk" food. If this cannot be accomplished with diet alone, adding bulk laxatives may be necessary.
• Drink plenty of liquids such as water, fruit juice and other beverages that don't contain caffeine – at least eight glasses of water a day.
• Limit alcohol consumption to one drink per day. Alcohol causes dehydration, which can lead to constipation.
• Monitor your salt intake. Excess salt in the diet causes fluid retention, which will cause swelling in all veins, including haemorrhoids.
• Regular exercise is important, especially if you have a sedentary job. Exercise helps by keeping weight down, decreasing constipation and enhancing muscle tone. Exercise often to promote regular, smooth bowel movements.
• Practice good bowel habits. Go to the bathroom as soon as you have the urge to move your bowels. Try to set up routine times when you can go to the bathroom without feeling as if you have to rush or strain. Once on the toilet, don't sit there any longer than necessary, because this can put additional pressure on the haemorrhoidal veins. Don't strain to pass stools. Be relaxed and give yourself time to let things happen naturally. Never hold your breath while passing stools.
• Modify your daily habits. Avoid prolonged sitting and/or standing at work or during leisure time. Take frequent short walks. If possible, avoid frequent lifting of heavy objects. If you must do heavy lifting, always exhale as you are lifting the weight; don't hold your breath when you lift.
• If you are pregnant, sleeping on your side will lower pressure on the blood vessels in your pelvis. This can help keep haemorrhoids from getting bigger.

Look after yourself.